Relationship between food insecurity and a gestational diabetes risk reduction intervention: outcomes among American Indian and Alaska Native adolescent and young adult females.

American Indian and Alaska Native (AI/AN) women are disproportionately impacted by gestational diabetes mellitus (GDM). GDM can cause severe perinatal complications for both mother and baby. Weight management through healthy diet and physical activity are key factors in decreasing risk for GDM. However, there are barriers to healthful eating in many AI/AN communities. Food insecurity, defined as the lack of consistent access to enough food for an active, healthy life, is a risk factor for unwanted weight gain. Living in a food insecure household during preconception and pregnancy may increase risk of greater weight gain. In this paper, we examined the relationship between food insecurity with healthy eating self-efficacy and behaviors among AI/AN adolescents and young adults (AYAs) (n = 149) through secondary analysis of an existing randomized controlled trial dataset. This study offers unique insight regarding "upstream causes" of GDM health disparities among AI/AN communities. Food security had some moderating effects on individual eating behaviors. Additionally, both healthy eating behavior and self-efficacy for healthy eating improved more among the AYA who experienced food insecurity at baseline. Given the intergenerational implications of GDM, it is prudent that the healthcare sector works with AI/AN communities to support healthful eating behaviors and environments to decrease GDM disparities.